Clinical experience of double plasma molecular absorption with a combination of two hemoperfusion machines in treatment of liver failure

Objective To evaluate the effect of the double plasma molecular adsorption system (DPMAS) with a combination of two hemoperfusion machines in treatment of liver failure.Methods A retrospective analysis was conducted.The clinical data from 42 patients with liver failure admitted to Tianjin Second People's Hospital from September 2012 to September 2013 were enrolled.Patients received 166 courses of blood purification treatment,including 97 courses of plasmapheresis (PE) and 69 courses of DPMAS.The DPMAS treatment was performed with a combination of two hemoperfusion machines,with one a blood pump and the other a plasma pump,for 2-3 hours.Liver function,tumor necrosis factor-α (TNF-α),electrolytes and blood routine were determined before and after treatment.Adverse reactions were observed and the nursing experiences were summarized.Results The survival rate of 42 liver failure patients was 64.29％,and the total bilirubin (TBil),NH3,total bile acid (TBA) and TNF-α were decreased and the albumin (ALB) was increased after PE and DPMAS.Further analysis of the rate of changes after treatment (after treatment/before treatment × 100％) showed that when compared with that in DPMAS,the TBil and TBA were decreased significantly in PE [TBil:(62.21 ± 5.51)％ vs.(64.39 ±4.61)％,t=2.683,P=0.008; TBA:(77.10 ± 4.44)％ vs.(85.91 ± 6.95)％,t=9.952,P=0.000],and the level of ALB was elevated significantly in PE when compared with that in DPMAS [(113.12 ± 2.90)％ vs.(101.87 ± 2.91)％,t=24.602,P=0.000].NH3 and TNF-α were decreased in both groups withe no statistical significance [NH3:(79.59 ± 5.72)％ vs.(80.56 ± 7.56)％,t=0.934,P=0.351; TNF-α:(61.66 ± 4.67)％ vs.(62.73 ± 3.67)％,t=1.638,P=0.108].The blood electrolytes and routine blood test showed that there was no significant change before and after treatments in DPMAS group [K+ (mmol/L):3.92 ± 0.83 vs.3.91 ±0.82,t=0.501,P=0.618; Na+ (mmol/L):136.89 ±5.69 vs.136.74 ±5.83,t=1.077,P=0.285; C1(mmol/L):96.58 ± 3.33 vs.96.55 ± 3.27,t=0.245,P=0.807; white cell count (× 109/L):5.22 ±0.93 vs.5.43 ± 1.11,t=1.125,P=0.265; hemoglobin (g/L):110.97 ± 19.20 vs.112.69± 19.67,t=0.643,P=0.522; platelet count (× 109./L):105.28 ± 26.82 vs.101.96 ± 3.08,t=0.727,P=0.470].Sixty-four out of the 69 courses of DPMAS treatment were successfully completed,and 5 times were ended because of line coagulation.There was no uncomfortable symptom complained by 53 patients during the treatment.Hypotension occurred for 3 times,and discomfort and nausea during treatment were complained for 9 times.Low fever occurred 4 times after treatment.Those uncomfortable symptoms were relieved spontaneously or by symptomatic treatment.Psychological nursing care should be given to the patients before and after DPMAS to relieve anxiety.Circulating tubes should be well rinsed to prevent line coagulation.General condition of the patient should be closely monitored in order to adjust therapeutic measures.Conclusion DPMAS could be effectively performed with a combination of two hemoperfusion machines without inadvertent side reactions,and it is safe in operation with smaller amount of plasma. Key words: Hemoperfusion;  Double plasma molecular adsorption system;  Plasmapheresis;  Liver failure;  Artificial liver support system